A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usuall...A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.展开更多
Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endo...Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases,we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.展开更多
Bile duct injury (BDI) is a well-known complication of cholecystectomy and can lead to the formation of a variety of complications, including biloma. Once diagnosed, the appropriate treatment depends on the severity o...Bile duct injury (BDI) is a well-known complication of cholecystectomy and can lead to the formation of a variety of complications, including biloma. Once diagnosed, the appropriate treatment depends on the severity of the condition and can range from minimally invasive procedures to more invasive procedures. We report the case of a 31-year-old woman who exhibited postoperative bile leakage after a cholecystectomy and a CT scan revealed a left hepatic subcapsular biloma. The patient was managed conservatively with close monitoring. The biloma resolved on its own without any intervention. Bilomas are rare complication of cholecystectomy that can be managed conservatively with a wait and see approach, especially in asymptomatic patients. Close monitoring with imaging and laboratory parameters is crucial in the management of these patients.展开更多
目的:探讨肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点。方法:回顾性分析2013年1月—2015年1月期间500例经肝动脉化疗栓塞介入手术(TACE)治疗的肝细胞癌患者的临床资料,分析患者手术后胆汁瘤发病的危险因素和临床表现。结果:500例...目的:探讨肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点。方法:回顾性分析2013年1月—2015年1月期间500例经肝动脉化疗栓塞介入手术(TACE)治疗的肝细胞癌患者的临床资料,分析患者手术后胆汁瘤发病的危险因素和临床表现。结果:500例患者中45例(9.0%)术后发生胆汁瘤。统计分析显示,存在胆道扩张、TACE术前肝切除史、非超选择性插管、使用聚乙烯醇(PVA)颗粒是患者介入手术后发生胆汁瘤的危险因素(均P<0.05)。45例胆汁瘤患者中10例为有症状胆汁瘤患者,主要为黄疸和发热,且胆汁瘤直径明显高于无症状患者(8.12 mm vs.21.84 mm,P<0.05),穿刺引流治疗后8例患者胆汁瘤缩小,2例消失;35例无症状组患者定期影像学随访。结论:对于有危险因素的肝细胞癌患者,应积极做术前好评估和预防工作。有症状的胆汁瘤患者应当进行穿刺置管引流治疗,无症状的胆汁瘤患者应当进行影像学随访,若胆汁瘤增大需要进行穿刺置管引流治疗,均能取得良好的预后。展开更多
Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed ...Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.展开更多
文摘A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.
文摘Biloma is an encapsulated bile collection outside the biliary tree due to a bile leak. It is occasionally found following traumatic liver injury or iatrogenic injury to the biliary tract, induced either during an endoscopic or surgical procedure. It is a rare complication of transcatheter arterial embolization (TAE). Although biloma can be shrunk by appropriate aspiration or drainage in majority of cases,we report a case of intrahepatic biloma following repeated TAE for hepatocellular carcinoma (HCC) and complicated by infection and intrahepatic stones. This particular constellation of problems has not been reported before and the intrahepatic stones need to be removed by percutaneous procedure.
文摘Bile duct injury (BDI) is a well-known complication of cholecystectomy and can lead to the formation of a variety of complications, including biloma. Once diagnosed, the appropriate treatment depends on the severity of the condition and can range from minimally invasive procedures to more invasive procedures. We report the case of a 31-year-old woman who exhibited postoperative bile leakage after a cholecystectomy and a CT scan revealed a left hepatic subcapsular biloma. The patient was managed conservatively with close monitoring. The biloma resolved on its own without any intervention. Bilomas are rare complication of cholecystectomy that can be managed conservatively with a wait and see approach, especially in asymptomatic patients. Close monitoring with imaging and laboratory parameters is crucial in the management of these patients.
文摘目的:探讨肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点。方法:回顾性分析2013年1月—2015年1月期间500例经肝动脉化疗栓塞介入手术(TACE)治疗的肝细胞癌患者的临床资料,分析患者手术后胆汁瘤发病的危险因素和临床表现。结果:500例患者中45例(9.0%)术后发生胆汁瘤。统计分析显示,存在胆道扩张、TACE术前肝切除史、非超选择性插管、使用聚乙烯醇(PVA)颗粒是患者介入手术后发生胆汁瘤的危险因素(均P<0.05)。45例胆汁瘤患者中10例为有症状胆汁瘤患者,主要为黄疸和发热,且胆汁瘤直径明显高于无症状患者(8.12 mm vs.21.84 mm,P<0.05),穿刺引流治疗后8例患者胆汁瘤缩小,2例消失;35例无症状组患者定期影像学随访。结论:对于有危险因素的肝细胞癌患者,应积极做术前好评估和预防工作。有症状的胆汁瘤患者应当进行穿刺置管引流治疗,无症状的胆汁瘤患者应当进行影像学随访,若胆汁瘤增大需要进行穿刺置管引流治疗,均能取得良好的预后。
文摘Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.
